DOI: https://doi.org/10.22141/2224-0713.6.92.2017.111589

Neurophysiological predictors of circulation-metabolism relationship in chronic cerebral ischemia

T.V. Cherniy, M.A. Andronova, V.I. Cherniy, Andronova I.A.

Abstract


Background. Early preclinical diagnosis and prevention of further progression of vascular dyshemias are the main directions of the struggle with severe health and social consequences of cerebrovascular pathology. The inclusion of analysis of the bioelectrical activity of the brain and cerebral blood flow is adequate and productive to describe the current functional status of patients with dyscirculatory encephalopathy (DE) of various origins, prediction of disease outcome and success of recovery. The purpose of the study was to promote the efficiency of chronic cerebral ischemia diagnosis by improving early detection and monitoring of a chosen treatment from the public servants on the outpatient stage. The main direction of the struggle with severe health and social consequences of cerebrovascular pathology is an early preclinical diagnosis and prevention of further progression of vascular dyshemias. Materials and methods. This clinical and neurological examination is a part of the scientific research: “Hypertension and non-hypertensive (atherosclerotic) encephalopathy in civil servants: pathogenetic mechanisms, integral diagnostic criteria, individualized correction of drug therapy”. The study involved 63 people aged 40 to 68 years. The patients were divided into three groups that were statistically comparable according to the main disease — DE, gender and age. The first group consisted of patients with DE without concomitant hypertension (n = 20), the second group — of 28 people with hypertonic discirculatory encephalopathy (HDE), the third one — of 15 patients with dyscirculatory encephalopathy and stroke in anamnesis. Among the examined patients, there were 21 men and 42 women. The diagnosis was confirmed by physical, clinical, neurological, laboratory and instrumental examination, neuropsychological studies (Mini-Mental State Examination, scale of stress, anxiety, Depression Anxiety Stress Scale-21). The control group of healthy volunteers included 20 people. Registration of brain potentials was performed using Tredex Expert computer electroencephalograph. We have studied absolute power — AP (µv/√Hz), relative power — RP (%) for the above-mentioned frequency bands. Evaluation of quantitative indices of the electroencephalography (EEG) was performed using integrated quantitative analysis of intra- and interhemispheric coherence of the studied frequency bands. To determine the maximum systolic blood flow velocity (cm/s) and end-diastolic blood flow velocity (cm/s), resistivity index (r.u.), systolic-diastolic Stuart index (r.u.), there was performed transcranial Doppler study of cerebral vessels of the head and neck. We investigated cerebral blood flow in common carotid artery, internal carotid artery, middle cerebral artery, vertebral artery and basilar artery. The database was generated according the results of researches. Primary preparation of tables and intermediate calculations were performed on a PC using Microsoft Excel software package. Mathematical processing was performed using standard statistical packages Statistica 6.0. Results. When studying three groups of patients with DE of various origins, there was found an increase in AP of all the investigated ranges, but with different degree. In all the examined groups, RP of alpha-1 and alpha-S bands reduced significantly. The maximum decrease in the RP of the alpha rhythm was observed bilaterally in the frontal, central and occipital departments. An increase was noted in RP of beta frequency rhythm due to the activation of the b1 wave range and activation or a tendency to it in the b2 rhythm in all leads. Group 1 was characterized by a significant level of disorganization of the EEG pattern due to the minimal — in comparison with other groups of research — levels of AP: a, a1 and b1 bands, at the maximal values of RP: d and b2 bands, the highest levels of the 1st and 2nd integral coefficients reflecting the prevalence of the influence of the structures of reticular formation upper part of the brainstem level of nonspecific regulation and functionally related structures of the left hemisphere on the formation of a complete electrical picture of the brain. All of the above mentioned features of the EEG were combined in patients of the group 1 with the maximal (in comparison with other groups of the study) reduction of indicators of blood flow velocity in the main intracranial carotid vessels on the left. Patients of the group 2, in contrast to patients of the group 1, demonstrated less pronounced level of EEG disorganization with the maximum level of a and a1 activity against the background of minimal activation of d and b2 bands of the EEG, which should be regarded as the manifestation of a high level of tension in the systems of nonspecific central nervous system regulation of thalamic  level, with moderate deficiency of the brainstem level of nonspecific
regulation. All this was combined in patients of the group 2 who have the highest systolic and diastolic blood flow velocity in the left internal carotid artery as compared to the other groups indicating no significant hypoperfusion, energy and mitochondrial failure. The degree of impaired blood flow due to circulatory or elastic changes in the great carotid vessels in patients of the group 1 directly correlates with the functioning of the upper part of the brainstem structures of nonspecific regulation and the related structures of the left hemisphere of the brain, and in patients of the group 2 — with the functional state of the diencephalic and thalamic systems and related structures of the right hemisphere of the brain. Conclusions. The conducted analysis shows the similar changes in the circulation-metabolism relationship in patients with HDE and DE. The change of cerebral blood flow is a compensatory response to maintaining adequate cerebral metabolism at a certain stage of DE development (degree 2). Changes of cerebral blood flow in patients of the group 2 are accompanied by compensatory changes in circulation-metabolism system: irritation of alpha and beta-1 activity and inhibition of delta-activity. The decrease in the cerebral blood flow velocity and vascular resistance in patients of the group 2 is associated with activation of low-amplitude slow-wave activity.


Keywords


chronic cerebral ischemia; quantitative electroence­phalography; transcranial Doppler

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